ABSTRACT: Empyema thoracis results as a sequele of postpneumonic effusion of aerobic and anerobic bacterial origin. If untreated, empyema thoracis runs through an exudative, fibro-purulent and an organizing phase. Our intervention of empyema thoracis with thoracoscopic decortication in the early phases has led to dramatic decrease in the complications as well as in the incidence of late phases of thoracic empyema. Nine patients were treated during the last 2 1/2 years with thoracoscopic decortication. The age of the patients varied from 2 years to 9 years. Two patients open decortication due to large fibrous peel which could not be brought out endoscopically.

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ABSTRACT: Two patients who developed lower gangrene following intramuscular injection of long acting penicillin (penidure LA) are described. Case 1, a 7 1/2 year old boy was administered benzathine Penicillin G intramuscularly in his right thigh for skin infections affecting both thighs and groins. Over the next 2 days his right lower limb started to turn yellow with progressive gross gangrenous changes of his right foot and leg with blotchy ecchymotic areas over the upper part of his right leg. Case 2 was a 9-year old girl, who received intramuscular Benzathine Penicillin G at monthly intervals for prophylaxis of Rheumatic fever. After one such injection patchy discoloration of her left thigh and adjacent knee was noticed. The left foot and leg soon after became gangrenous. After establishment of the line of demarcation, a below knee amputation was performed in both the cases.

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ABSTRACT: The authors report their initial experience in the laparoscopic treatment of congenital inguinal hernia in children. Methods Between February 2001 and October 2001,45 children, 42 boys and 3 girls between 1 month and 10 years of age were treated laparoscopically for inguinal hernia repair; 28 patients (62 percent) presented with right inguinal hernia while 5 patients (11 percent) had left inguinal hernia. The repair involved placement of purse-string suture around the internal orifice of the inguinal canal. A routine search was undertaken for contralateral patent processus vaginalis, which was found in 8 patients (18 percent) and was repaired simultaneously. Twelve patients (27 percent) were found to have bilateral inguinal hernias. Results The surgery lasted 20 to 45 minutes, the duration decreasing with experience. There were no intra or postsurgical complication. Recurrence was noted in 1 patient (2 percent), Which was repaired successfully by laparoscopy. Conclusion The early results suggest that laparoscopic surgery is a safe and feasible technique for the treatment of patent processus vaginalis and inguinal hernia in children. It is also an accurate procedure for exploration and repair of contralateral patent processus vaginalis in children saving the trauma and morbidity of a second surgery.

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ABSTRACT: Color Doppler Ultrasonography is being increasingly used in testicular torsion to differentiate it from acute epididymoorchitis. Three children in whom the diagnosis of acute epididymoorchitis was made based on the above test subsequently developed testicular atrophy. The need for early exploration in doubtful cases is stressed in this article.

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ABSTRACT: Neuroblastoma and Wilms' tumor are the common intra-abdominal malignancies of early childhood and it is important to differentiate between the two, as the management and outcome of these malignancies are very different. A neuroblastoma arising from the kidney or an aggressive neuroblastoma invading the kidney may be easily misdiagnosed as a case of Wilms' tumor preoperatively. We report a similar case of intra-renal neuroblastoma where we failed to pick up the diagnosis of neuroblastoma preoperatively. Any intrarenal tumor crossing the midline, encasing the aorta and vena cava or having massive retroperitoneal lymphadenopathy should point to a diagnosis of intrarenal neuroblastoma.

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ABSTRACT: Transurethral fulguration of neonatal posterior urethral valves (PUV) is often not possible in many centers in India due to the lack of adequately small cysto-urethroscopes. We have avoided urinary diversion in one neonate by fulgurating the valve transvesically using a 14F resectoscope.

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ABSTRACT: Pilomatrixoma are rare, benign, calcifying cutaneous tumors of the matrix cells of the hair follicle. They usually present in childhood and show no signs of spontaneous regression. Clinical differentiation from epidermoid cyst is almost impossible. Usual sites of appearance are head, neck and upper extremities. It is associated with other diseases and can be multiple. simple excision with the overlying skin, suffices as adequate treatment. A case of pilomatrixoma in a 6-year old girl was removed from the neck behind the right ear. The girl is doing well now.

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ABSTRACT: This report describes an unusual presentation of Meckel's diverticulum in a 2-day old male neonate. The clinical presentation was small bowel obstruction. Plain abdominal X-ray was suggestive of segmental small bowel dilatation. Laparotomy revealed a greatly distended Meckel's diverticulum; the intestine immediately distal to the diverticulum was kinked and trapped in its own anomalous artery. Resection of the distended diverticulum and restoration of bowel continuity was curative. This is a unique presentation of massive dilatation of Meckel's diverticulum in a neonate.

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ABSTRACT: Diagnostic laparoscopy by closed method (Veress needle) was performed in 20 patients aged 6 months to 12 years (average 4 year 7 months) who had 23 impalpable tests (3 patients with bilateral impalpable testes). Patients in whom blind ending vas and vessels were noted or in whom vas, vessel or testis could not be located, operation was avoided (3 patient), In the other patient open exploration was done. there was no complication related to the laparoscopic procedure. The information gained from laparoscopy not only helped in localizing the testis but also in formulating further management.

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ABSTRACT: Peripheral arterial aneurysms are very rare in the pediatric age group. Two cases of aneurysm, a radial and a brachial aneurysm are presented here. Both were false aneurysms and were treated successfully by ligation of the artery and excision of the aneurysm.

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ABSTRACT: This is the report of a 13-year old girl who presented with symptoms of coughing after feeds and recurrent chest infections for past 3 years. Chest radiographs demonstrated consolidation. Contrast swallow and upper GI endoscopy demonstrated a left esophagobronchial fistula. Surgical treatment completely cured the patient.

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ABSTRACT: A female child aged 1 year and 7 months was admitted with huge abdominal distension for 2 month following recent blunt abdominal trauma. She was diagnosed to have chylous ascites which was refractory to repeated paracentesis. Exploratory laparotomy and repair of chyle leak at the root of the mesentery was done. The patient recovered and is doing well after a follow up of 1 year.

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